Will Insurance Alone Cure What Ails Us?

(CBS)  Baystate Medical Center is the second busiest emergency room in Massachusetts. They treat over 100,000 patients a year, but here's the thing: according to Dr. Niels Rathlev, who runs the ER, a quarter of them don't need his services.

"Well I think the way I would phrase it is to say I think that there are alternate sites of care that would be more appropriate," Rathlev said.

He means a doctor's office - a primary care doctor's office, reports CBS News contributing medical correspondent Dr. Sanjay Gupta.

"The majority of patients who are frequent utilizers of the emergency department actually have insurance," Rathlev said. "They have a primary care physician, but they choose to come to the ER because they don't have access."

Like Kenneth Mills, who is in pain from a bowling injury.

"I went and called my doctor this morning," Mills said. "But I wouldn't be able to get in to see him."

Mills is bruised, not broken, and could have easily been treated outside the ER.

"Are you kind of surprised that you had to come to the emergency room to take care of something like this?" Gupta asked.

"Well, I wish I had a primary I could just call and come in and I wouldn't have to wait as long," Mills said.

That's the issue: just having insurance doesn't guarantee access. There aren't enough doctors.

It's a real problem. In fact, according to the Department of Health and Human Services, we're more than 16,000 primary care doctors short in The United States.

About 26,000 new doctors enter the workforce each year, but only 6,500 enter primary care. One reason is that starting salaries for primary care doctors are a lot lower than for specialists - like in radiology, cardiology and urology.

"I've been in practice for 10 years and I still owe $60,000 in student loans," said Dr. Kate Atkinson from Amherst, Mass.

But it's not just the pay, it's the paperwork. Atkinson is drowning in it and says that's what's keeping doctors away from primary practices.

The reality here is that Atkinson and her nurse practitioner treat 3,000 patients, but filling out hundreds of different forms takes a staff of 11- so she simply can't make ends meet.

"Do you know that I lost a staff person to Starbucks last year because they could pay her more money than I could pay her?" Atkinson asked.

So how do you increase the number of family physicians?

Gupta thinks money plays a role. There has also been discussions of medical school loan forgiveness programs, which might help. But it's also the paperwork - it makes it hard for primary care physicians to get work done.

[jschmidt27]

before everyone goes jumping at the public option, look at what the other countries that have a single payer system are facing. Doctors feel they are not being compensated enough and hospitals face deep loses and will need to cut care. So look where you're heading before you jump. Public option will eventually lead to single payer when Congress decided in the future public optin is too expensive and throws more money into it making it less expensive than private insurance. Also has anyone looked at the affect of through 40 million uninsured people into a system that is already short of doctors and nurses, hospitals are losing money and the govt wants to cut medicare reimbursements. Medicare, a govt run program, is already faced with massive deficts so tell me why a public option would be run any better. http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/countries/

[Weenchit]

There is one aspect of this healthcare reform debate that never gets talked about and I this article reminds me of it. Supply of doctros is an issue. As it stands, the medical practice is kept much smaller that it should be. There are a few excuses for this but we can see the end result: restricted supply coupled with nearly unlimited demand. One critical component to reforming healthcare without resorting to a government system would be to stop this. There are so many, many students that are rejected from medical school who would make fine doctors. They are not rejected because they don't meet standards. They are ultimately rejected so that the profession can be kept small. A large number of doctors competing for patients would provide an incentive to increase service quality while keeping prices down. This change, along with legal and insurance reform would allow free markets to bring our healthcare system back to health.

[AK-47_Justice]

I'd be willing to bet you cannot offer substantiated proof of your claims here showing that the profession is kept small on purpose, but the fact of the matter today is that many more doctors move on to specialized fields where the pay is much higher, and only 29% of those graduating today become GP's, at an average of $175K per year.

[SAMTORRES66]

The Cost for health care starts at medical school. If Obama wants to reduce cost, the goverment should pay for medical school & provide the colleges with all the trainig equipment, revamping the insurance system alone wouldn't do it.

[eclecticman1]

After reading the articel, I think a nationally funded program for family doctors would be a huge boost for all of us. This should be added to the billl.

[mike60min]

I worked for IBM servicing computers in the health care industry. The Computers were linked nationally to each other, primarily, for keeping track of Price increases of any procedure nationally. If a cost of a service went up in New York, in Iowa, the computer "ticked up" in price. There were "boiler rooms" of thousands of computer terminals where billing took place. Doctors paid thousands annually for this "service". The computers, worth billions and the thousands of data entry workers with only one function "Billing". It is no wonder, the doctor is buried in paperwork. The insurance plan I have, does not pay anything. They dismiss visits as "Preventive" and not covered. Blue Cross is a "For Profit" and could care less about "Servicing my health care needs". They are only interested in "Profit" and hoping my health will deteriorate so they can charge "Big bucks" like heart Stents, one day in and out of the hospital $40,000 to Medicare.
I have no confidence, unfortunately, that my doctor is making decisions for my benefit, and not for the benefit of the "For Profit" health care Cartels.
It is going to take a national effort to reverse the "For Profit Health Care Industrial Complex" to a "Health Care Service" removing the "For Profit only" Health Care we have today.
If the Health Care Industrial Complex is successful, we will be sliding into a "third world" or deeper in the abyss financially.
We have a process that can change it, the 565 people in Congress can do it, if they just step back and open the door to reform for the benefit of our countries citizens and not the top 1% who are part of the 35,000 lobbyists that give the average US Senator $8 million to get re-elected in return for voting for "For Profit" entities like Health Care.
I pray the 565 are NOT duped into doing nothing like they were in 1994, where we had 34 million Uninsured, that has climbed to 47 million today. If not, the uninsured will be 60 million in 2018.
The "For Profit" Health Care Industrial Complex including Billing, Tort reform, Drug Company kickbacks, Hospitals, TV advertisement of drugs and Ambulance chasing lawyers who sue our health care providers are all part of the Outrageous cost.
We sometimes "pat ourselves on the back" as America is a "Great Country". When in fact, for decades now, we are sliding to "third world" status, the For Profit Health Care Industrial Complex is just one thing that "Needs to be fixed".
We need to "get started" with an open door to health care reform (aka reduce the costs) as a First Step, that will then address the billing nightmare, the Drug Kickbacks to doctors, the Ambulance Chasing Lawyers, and idiot costs like advertising for Viagra and Cialis on TV.

[AK-47_Justice]

by mike60min
"I worked for IBM servicing computers in the health care industry."

"We sometimes "pat ourselves on the back" as America is a "Great Country". When in fact, for decades now, we are sliding to "third world" status, the For Profit Health Care Industrial Complex is just one thing that "Needs to be fixed".
We need to "get started" with an open door to health care reform (aka reduce the costs) as a First Step, that will then address the billing nightmare, the Drug Kickbacks to doctors, the Ambulance Chasing Lawyers, and idiot costs like advertising for Viagra and Cialis on TV."
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Exactly! We need REAL health care reform to cut the cesspool of waste and abuse, and starting with electronic billing and medical records would save tens of billions out of the current $2.5 Trillion cost!

It is pure insanity to resist this any longer, while we continue to have to watch TV ads and know that the for-profit health care industry is spending another $1.4 Million per day to fight any changes!

[AussieHugh]

I am staggered that in the US there is not electronic communication between doctors and insurance companies.

In Australia i can go to a doctor and using my medicare card (we have basic universal coverage) can have my account processed and the payment is in the doctors account the next day.

If I use my private insurance then I have a HICAPS card. This is a card that is issued by ALL health funds. For many services the service provider will swipe my card, put in the service code (this is standardized for all medical procedures.) The health fund computer processes my claim and sends the payment to the practitioner and I pay any co-payment.
If I need to go to hospital as a private patient I lodge a claim with my private fund who shares the infomation with medicare and everything is resolved with no drama for me.

I cannot believe that the US health funds are not able to set up the same thing. They would be able to cut processing costs and still make an obscene amount of money and may pass the savings on or pay more to their CEO.

Its called computers people. You invented them, use them.

[AK-47_Justice]

by AussieHugh
I am staggered that in the US there is not electronic communication between doctors and insurance companies.

In Australia i can go to a doctor and using my medicare card (we have basic universal coverage) can have my account processed and the payment is in the doctors account the next day.
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Great point from Australia, that just shows how tough it is to fight the status quo here in America.

I was working in the electronic claim's field in its infancy 20 years ago, but the doctors and especially their controlling office managers, fought tooth and nail against computerized billing and claims, despite knowing that it would save them both time and money!

To see a GP's office overwhelmed with non-standardized claim's forms despite 11 employees, and waiting months for payments with the for-profit insurance companies, proves that the status quo is not just detrimental to health care, but part of the cesspool of waste and abuse!

[AK-47_Justice]

by AussieHugh
"I am staggered that in the US there is not electronic communication between doctors and insurance companies."

"Its called computers people. You invented them, use them."
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Yep.....not only would computers save time and money in billing and claims. but also help improve that communication between different doctors, requiring fewer duplicate tests that also increase costs!

This is exactly why the cost in Australia is $2,999 per person and $7,249 per person for health care in America!

[pepperwood2]

Will Insurance Alone Cure What Ails Us? .... Insuring All Americans Won't Help if There Is a Shortage of Primary Care Doctors.

To show The People that The President, The Liberal Elite & AARP, are on the same page, they have agreed to offer FREE Prostrate Tests for All Women & FREE Pap Tests for all Men that enroll in The Obama Moveon Medical Plan. These are added coverages that are not even offered in The Health Care Plan that our Congress has privy to. Compliments from Obama to show he hasn't loss touch with The People. So Sad!

[notsouthern]

US (and mostly southern) Republicons are the only supporters of more of the same and most expensive health care system on earth: Republicon Style, sell out to the Fascists at FOX, and their Corporate America Southern Brothers at United Health, or UNH! Look for the southern and Republicon fascists to cowar in their southern states cowardice while we American's strive for solutions.

[notsouthern]

Republicons have not figured out that their opposition to a public health plan will cost them even more seats in Congress in 2010. Democrats will have many months prior to the Nov. 2010 elections to educate the American voter that the Republicon obstructionists are wrong for America, as they always have been, and that Republicon obstructionists are the number one reason why the USA has the most expensive health care system on earth.

[notsouthern]

Republicons have not figured out that their opposition to a public health plan will cost them even more seats in Congress in 2010. Democrats will have many months prior to the Nov. 2010 elections to educate the American voter that the Republicon obstructionists are wrong for America, as they always have been, and that Republicon obstructionists are the number one reason why the USA has the most expensive health care system on earth.